While helping clients with their Medicare plans, I have found a great amount of confusion among them about how Medicare assists those needing assistance, which depends on whether they need skilled nursing or custodial care like nursing home care, assisted living care, community care or home care.
What Medicare does cover is Skilled Nursing, which is fully covered for 20 days and up to another 80 days where the cost is shared by the Medicare beneficiary and Medicare. Skilled nursing is designed to assist one while they still have an “acute” medical condition. In layman’s terms this means they are at risk of death or serious adverse health outcomes. As soon as their health stabilizes, they are usually released from Skilled Nursing and Medicare ceases paying.
Long Term Care is known as custodial care, meaning the beneficiary needs help with the Activities of Daily Living but does not have an Acute medical condition. This type of custodial care is not covered by Medicare. You basically have three options, 1) Pay for the care personally from your assets, 2) Apply for state Medicaid if you have very few assets, not counting your home and one vehicle, and a low income. 3) Purchase Long Term Care Insurance (LTCI) either as a standalone plan or through a life insurance policy with a provision that allows you to receive in advance a large portion of the death benefit to pay for your care.
Long term care costs usually begin when a beneficiary becomes unable to perform at least 2 of the “six activities of daily living guidelines” which are: Bathing, dressing, toileting, transferring, eating and continence. The long-term care plan is then ‘triggered’ to begin making payments to the beneficiary. The cost of these plans varies with the age and health status of the beneficiary. The rule of thumb is that the best time to acquire one of these plans is when you are relatively young and healthy.
If you would like to know more about long term care issues, I can be emailed at ewilliams@actiongroup.net or by phone at 248-366-8680.
Edward Williams, CLU
Action Health Insurance Agency, LLC